Healing Center

As unglamourous as they are (and you'll never see a telethon for hemorrhoids), consider yourself very fortunate if hemorrhoids are your worst experience with ill health. Try as you might, you simply cannot die from hemorrhoids. They may swell and become quite painful. Or itch. Or bleed. But 'rhoids will never do you in. As you might be aware, hemorrhoids are simply varicose veins that have developed in an unfortunate location. When they do bleed, it's never very much actual blood. (But don't ignore bleeding. Over time, you can actually get quite anemic.) The only serious complication (relatively speaking) is thrombosis, when a clot forms within the hemorrhoid, and that is indeed quite painful and usually needs a surgeon's help. For simple hemorrhoids, we suggest a few easy steps that can reduce your discomfort in minutes. And our WholeHealthMD Healing Center also has recommendations that might actually slow down their progression and reduce your chances of problems in the future.

This chart indicates at a glance the herbal and nutritional supplements that I and other WholeHealthMD practitioners have found most helpful for this ailment. We've also provided specific dosages and other useful tips.

Hemorrhoids, also known as piles, are actually just enlarged (varicose) veins that occur in the anus or rectum. Because the veins in these areas are located in the lower part of the body, gravity causes the blood to pool in them instead of flowing back to the heart. This causes the veins to stretch and weaken. The blood can also sometimes flow backward, since these veins lack valves to prevent this.

When veins enlarge, two types of hemorrhoids can developâ€”internal and external. Internal hemorrhoids form inside the rectum, about an inch above the anus. Though they can cause bleeding after a bowel movement, they are painless and cannot be seen or felt easily. However, internal hemorrhoids can painlessly pop out through the anus (prolapse). Patients quickly discover that prolapsing hemorrhoids can be reinserted with gentle manual pressure. External hemorrhoids form around the anal opening. These hard, itchy, tender bumps are fragile, so they are likely to be tender and bleed easily after a bowel movement or when wiped with toilet tissue.

Prolapsed internal hemorrhoids become acutely painful if their circulation is constricted causing additional blood to build up in them. If a prolapsed hemorrhoid develops a blood cloth (thrombosis) inside it, it may become too hard and large to reinsert. This can result in loss of blood supply to the whole hemorroid (strangulation) similar to ligation. But without having actually tied off the vein, hemorrhage could ensue as it degenerates.Fortunately, this is an uncommon event, which is quickly remedied with a surgical procedure. Doctors recommend that repeatedly prolapsing hemorrhoids undergo surgical removal to avoid this painful occurrence.

Hemorrhoids are a common problem, afflicting nearly three-quarters of all Americans at some point in their lives. Because they cause few symptoms, however, some people are not even aware that they have them. While hemorrhoids can be a nuisance, they are not a serious health risk.

The main cause of hemorrhoids is straining during bowel movements, which exerts extra pressure on the blood in the anal and rectal veins. This straining is often the result of difficulty getting rid of the content of the large bowel (constipation) caused by dehydration or inadequate fiber in the diet.

Other possible causes are:

Pregnancy, childbirth or obesity, all of which put excess pressure on both the upper and lower abdomen causing a reduction in the return of venous blood from the abdomen back to the heart through the liver (the portal circulation).The venous blood takes an alternate path back to the heart, including a path through the hemorrhoidal veins, with the additional blood and pressure inside the veins resulting in enlarging and weakening them

Prolonged periods of sitting or standing

Loss of muscle tone due to old age or rectal surgery: some muscles help pump blood through veins

Mild cases of hemorrhoids are primarily treated by drinking plenty of fluids and increasing fiber in the diet in order to keep the stool soft. A variety of over-the-counter topical hemorrhoid treatments may help to reduce pain and swelling. A doctor may also recommend taking daily sitz baths to ease pain and itching.

Surgical treatment of internal hemorrhoids includes rubber band ligationâ€”placing a tiny rubber band around the hemorrhoid, which cuts off the blood supply and causes it to wither and fall off. Cryosurgery â€“ applying extreme cold to destroy tissue â€“ also may be used to treat internal hemorrhoids. A procedure called sclerotherapy, which involves injecting a chemical solution (like concentrated salt water) into the vein is another option to treat internal hemorrhoids. The sclerosing solution causes inflammation inside the vein and this leads to scarring, causing the hemorrhoid to shrivel-up and fall off. Prolapsing hemorrhoids require a hemorrhoidectomy â€“ surgical removal of the hemorrhoid â€“ or a less invasive option, such as a Transanal Hemorrhoidal Dearterialization (THD) procedure.This consists of using a Doppler ultrasound to identify and "tie-off" the arteries that provide blood flow to the hemorrhoids. As a result, the size of the hemorrhoids decreases (becomes â€œdecongestedâ€ of blood) with a reduction in pain, swelling and bleeding tendency.

External hemorrhoids can be diagnosed by a simple physical examination. For internal hemorrhoids, a doctor may need to do a rectal examination (inserting a gloved finger in the rectum). An anoscope can be used to look inside the anal canal. A proctoscope and a sigmoidoscope also can be used to look progressively deeper, inside the rectal canal and the distal part of the lower intestine, respectively.

Taken together, vitamin C, flavonoids, and the herb butcher's broom can help to tone and shrink enlarged veins. These supplements have been shown to strengthen veins and improve circulation overall, alone and in combinations such as butcher's broom taken along with vitamin C. (1-6) While butcher's broom has a long history of traditional use for hemorrhoids, scientific evidence is lacking.

Some of the most promising studies regarding hemorrhoids involve flavonoids. Several studies have shown the flavonoids hydroxyethylrutosides (HERs) help to relieve signs and symptoms of hemorrhoids in pregnant women as well as non-pregnant patients. (7-10) In one study, 90% of pregnant women taking HER (1,000 mg daily for four weeks) showed improvement in symptoms, compared to only 12% in the placebo group. (7) In another study, 50 pregnant women with acute hemorrhoids took a flavonoid combination (90% diosmin and 10% hesperidin) for eight weeks before delivery and four weeks after delivery. Symptoms had dissipated in 66% of women by the fourth day of treatment, and fewer than half of the women had relapses before delivery. Treatment was well accepted and did not affect pregnancy, fetal development, birth weight, infant growth or feeding. (10) More research is needed.

Zinc helps to speed the healing process. (11) In a 2005 study of 252 patients with mixed hemorrhoids, using a suppository cream containing zinc oxide (Titanoreine) resulted in increased and more rapid pain relief than the control cream. However, no significant changes were noted in symptoms such as bleeding or edema. (12) In another study, Titanoreine cream improved wound healing time after surgery for prolapse and hemorrhoids. (13)

Psyllium is rich in soluble fiber and has been shown to provide significant relief in bleeding and pain caused by hemorrhoids. In a placebo-controlled, randomized study of 50 patients with bleeding internal hemorrhoids, supplementation with psyllium led to significantly less bleeding (detected by endoscopy) compared to a control group. In the psyllium group, hemorrhoids bled on contact in 5 out of 22 patients before treatment and in none after treatment; no improvement was noted in the control group. (14) Another study showed that taking psyllium along with a flavonoid combination seems to help relieve bleeding from non-prolapsed hemorrhoids. The study also showed that taking psyllium with the flavonoid combination relieves bleeding more rapidly than psyllium alone or when used with rubber band ligation. (15)

Flaxseeds are another great source of fiber and can help to ease the passage of stools and pain from hemorrhoids. While large studies have shown efficacy of flaxseed as a source of dietary fiber that produces a bulk forming laxative effect, research regarding the use of flaxseed to treat hemorrhoids is lacking. (16, 17)

Witch hazel is another popular topical remedy in the form of creams, gels, glycerin, or pre-medicated wipes. Traditional medicine indicates applying witch hazel topically may help to relieve itching, discomfort, irritation, and burning associated with hemorrhoids. (18) Avoid alcoholâ€“based witch hazel products, however, as they will be very irritating to rectal and anal tissues.

Consuming wheat bran prophylactically has been shown to reduce the risk of hemorrhoids. (19, 20) In one study, eating a high-fiber diet of unprocessed bran for 18 months increased the long-term cure rate (decreasing recurrence) among 92 patients with severe hemorrhoids initially cured by rubber band ligation. (19)

Because hemorrhoids are the result of weakness of the walls of the veins, using the herbal "vein tonic" horse chestnut may help to increase the muscular tone of the vessels and keep the veins from bulging. A 2001 review of conventional and alternative treatments for hemorrhoids indicates that taking horse chestnut prophylactically may prevent symptoms and problems resulting from hemorrhoids. (21) Another review found that the anti-inflammatory and pro-circulatory effects of aescin, the active agent in horse chestnut, may be beneficial to patients with hemorrhoids. (22) More research is needed to confirm or refute efficacy. (Be sure to use a commercial product and not parts of a tree. Unprocessed horse chestnut may contain toxins.)

For painful hemorrhoids, an oil or ointment containing the herb St. John's wort may help, especially after bowel movements. The anti-inflammatory, antibacterial and antiviral properties of this herb may help to relieve pain and itching, as well as to shrink the inflamed and swollen tissue. While some alternative sources indicate this use for St. John's wort, scientific studies are lacking. (23, 24)

Leaves from the plant gotu kola(Centella asiatica) have been shown to have therapeutic properties, including improving blood flow and elasticity of blood vessels associated with hemorrhoids. (21, 25) Study results have been somewhat promising, showing that topical application of Centella extract (TTFCA) three times daily improves vascular tone in hemorrhoidal vessels. (21) More research in this area is needed, however.

The anti-inflammatory properties of Ginkgo biloba may help to ease inflammation, bleeding and pain associated with hemorrhoids. Alternative sources indicate Ginkgo is effective in controlling the acute phase (bleeding) so that definitive therapy (banding, injection sclerotherapy, cryotherapy or surgery) can be scheduled at a convenient time. (5)

A poultice made from elderberryalso may help to soothe swollen veins and relieve pain. This fruit, which contains several flavonoids, has been shown to have anti-inflammatory properties and may help to reduce swelling in hemorrhoids. (26, 27) However, elderberry has not been studied for this use.

For external hemorrhoids, try ice compresses or warm-water sitz baths two or three times daily. Some alternative medicine texts recommend â€œcontrast hydrotherapy.â€ Using two basins, one filled with hot and one with cold water, sit alternately in hot water for three minutes, then in cold water for one minute. Repeat this alternating treatment three times for one set. Do one or two sets a day for three to four times a week. (28)Studies have shown that a hot sitz bath seems to relieve pain through relaxation of the anal-sphincter muscle. (29-31)

Apply a poultice made from elderberry to soothe swollen veins and relieve pain. Grind a small amount of the herb, mix with warm water until it becomes a paste, spread on gauze, and apply to anus for a couple of hours. A poultice made from grated potato can also be soothing and astringent. (28)

After a bowel movement, clean the anal area thoroughly but gently. Use soft toilet tissue moistened with warm water or witch hazel, or pre-moistened wipes. To dry the area, dab--don't scrub--it with a soft, clean disposable cloth. Another alternative for drying the area is to use a blow dryer. Do not be too aggressive during cleaning, as this can inflame veins.

Homeopathic sources indicate that some remedies help to relieve pain and speed healing in hemorrhoids. (32, 33) Homeopathic remedies are classically prescribed on an individual basis, depending on the specific symptoms in each case. A few of the commonly indicated homeopathic medicines for hemorrhoids include:

Aesculus for burning hemorrhoids with a sensation of a lump in anus and aggravation from walking

Aloe for a sensation of pulsation in the rectum with large, external hemorrhoids

Hamamelis for large bleeding hemorrhoids with raw feeling in the anus.

Take 3-5 pellets of a 12X to 30C potency every one to four hours until acute symptoms resolve. (28) (Note: â€œpotencyâ€ in homeopathy refers to the number of serial dilutions used for preparing the medicine, more dilute = more potent. Please see the â€œHow it worksâ€ section in the WholeHealthMd article on homeopathy for a more extensive explanation.)

Ideally, the homeopathic medicine chosen would match the patient's mental and emotional state as well as the specific symptoms associated with the condition. However, very few studies have examined the effectiveness of specific homeopathic remedies: this highly personalized approach makes a controlled study difficult.

Acupuncture has been used to treat hemorrhoids, and preliminary evidence indicates improvement of pain after treatment. (34, 35) One study involving electroacupuncture also showed efficacy to relieve pain during bowel movements. In the study, 120 patients received either electroacupuncture or conventional medication to treat hemorrhoids. Electroacupuncture treatment resulted in a significant reduction in pain during bowel movements compared to conventional medication. (36) More research is needed.

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

Supplement/
Therapy

Rating

Explanation

Acupuncture

Preliminary evidence indicates efficacy to reduce pain. More research is needed. (34-36)

Butcher's broom

Long history of traditional use, but scientific evidence is lacking.

Taken together, vitamin C, flavonoids, and the herb butcher's broom can help to tone and shrink enlarged veins. These supplements have been shown to strengthen veins and improve circulation overall, alone and in combinations such as butcher's broom taken along with vitamin C. (1-6) While butcher's broom has a long history of traditional use for hemorrhoids, scientific evidence is lacking.

Some of the most promising studies regarding hemorrhoids involve flavonoids. Several studies have shown the flavonoids hydroxyethylrutosides (HERs) help to relieve signs and symptoms of hemorrhoids in pregnant women as well as non-pregnant patients. (7-10) In one study, 90% of pregnant women given HER (1,000 mg daily for four weeks) showed improvement in symptoms, compared to only 12% in the placebo group. (7) In another study, 50 pregnant women with acute hemorrhoids took a flavonoid combination (90% diosmin and 10% hesperidin) for eight weeks before delivery and four weeks after delivery. Symptoms had dissipated in 66% of women by the fourth day of treatment, and fewer than half of the women had relapses before delivery. Treatment was well accepted and did not affect pregnancy, fetal development, birth weight, infant growth or feeding. (10) More research is needed.

Women, men, those over 50, those with chronic illness, and vegetarians have special needs to consider when choosing a multivitamin. Review your special needs below.

Why Everyone should be Taking a Multivitamin

There's nothing like a sound, low-fat diet full of fruits, vegetables, and whole grains to supply the vitamins and minerals we need to stay healthy. Unfortunately, we don't always eat well. Add to that the possible harmful effects of stress, aging, lack of exercise, pollution and illness, and supplements become even more important. That's why so many experts now recommend that everyone take a daily multivitamin.

The Right Choice: See Our Multivitamin Chart

This chart outlines the key vitamins and minerals your multivitamin should supply and the main benefits of each nutrient. It also gives what's called the daily value (DV) - a new government standard that generally corresponds to the RDA. The DV satisfies minimum daily requirements and helps prevent a deficiency disease, such as scurvy (lack of vitamin C). The higher levels of vitamins and minerals found in many multivitamins may actually help prevent disease, delay its onset or even lessen the severity of certain ailments.

Good Reason to Take an extra-strength Formula

If you eat an optimal diet of low-fat foods, at least five servings of fruits and vegetables daily, and chicken, lean meat, or fish several times a week, you can probably get away with a once-daily formula. But even those who consume a fairly well rounded diet and yield to junk-food lapses only occasionally can benefit from an extra-strength formula. If your idea of lunch is a slice of pizza and a diet soda, look for a multivitamin in the upper ranges of our chart.

•Read the label carefully to see
what you're getting. Many "high-potency"
formulas provide only extra amounts of the less-expensive ingredients.

•Don't pay more for "timed-
released" or "related" products. They're not worth the extra cost.

• Check the serving size. You may need to swallow up to six extra-strength pills a day to get the amounts listed on the label.

•Don't double up on one-a-days You'll be getting too much of certain nutrients, and not enough of others. If you want an extra-strength formula, buy one.

• Avoid mega doses that greatly exceed the upper doses listed in our chart, especially with fat-soluble vitamins A, D, E, and K; the minerals iron and selenium; or when taking any supplements long term. Be sure to account for any vitamins and minerals you may also be taking as individual supplements or as part of an herbal formula.

Fights infections; maintains eye and skin health. May be supplied in part as beta-carotene, which may lower the risk of cancer and heart disease and boost immunity. Pregnant women should not take more than 5,000 IU of vitamin A daily, but higher doses of beta-carotene are safe.

Promotes healthy bones and teeth; may protect against cancer.Adults may be deficient even with the usual doses of 400IU in multivitamins. Those over 50 should get at least 1000 IU and those over 70 may need at least 2000 IU of Vitamin D3. Avoid daily doses exceeding 10,000 IU, which may be toxic.

400 IU

200-400 IU

may need an additional 1000IU above what is in the multivitamin. Get a Vit D blood test to determine your needs.

Prevents anemia in younger women. Men and postmenopausal women should opt for iron-free formulas. Vegetarians who avoid all animal products and women with heavy periods should get at least 18 mg a day. Don't exceed 65 mg daily.

May cure colds, relieve prostrate complaints, and slow macular degeneration. Vegetarians who avoid all animal products, including dairy and eggs, should aim to get 30 mg. Don't exceed 60 mg daily, which can be harmful.

15 mg

15 mg

15-30 mg

Special Needs

Women

of all ages need at least 1,200 mg of calcium daily, through supplements or diet, to slow bone loss. Most multivitamins don't supply this much: A separate calcium supplement is probably your best bet. Younger women, especially those with heavy menstrual periods, need plenty of iron (18 mg a day ). Those considering pregnancy should get extra folic acid and avoid high-dose vitamin A. Special "women's formulas" may contain expensive herbs you may not need.

Men

should avoid multivitamins containing iron: Iron build-up has been linked to heart disease. Be wary of "men's formulas that tout ingredients like saw palmetto for prostate complaints. Many of these high-profile "extras" are present in such small amounts that they provide little or no therapeutic benefit.

Over 50,

opt for iron-free formulas: Too much of the mineral can cause heart problems. Look for vitamins B6 and B12 in the higher ranges, because as people age, they often have trouble absorbing these nutrients. Older women and men can benefit from the bone-strengthening effects of extra calcium (1,200 mg a day) and vitamin D (400 to 600 IU a day).

Chronic Illness

can lead to poor eating habits or deplete nutrient stores. Extra-strength formulas are especially important if you suffer from a long-term digestive ailment or have liver or gallbladder problems. Consult your doctor before taking supplements.

Vegetarians

who avoid all animal foods, including dairy and egg products, need at least 100 mcg daily of vitamin B12. Zinc, iron and calcium are also very important minerals for strict vegetarians.

Disclaimer: All material provided in the WholeHealthMD website is provided for educational purposes only. Consult your physician regarding the applicability of any information provided in the WholeHealthMD website to your symptoms or medical condition.